Consumer input into standards revision: changing practice

As part of ongoing quality improvement initiatives, the Canadian Standards for Psychiatric-Mental Health Nursing were recently revised. For the first time since the standards were published in 1995, the input of consumers of mental health services was sought. Thirty-one consumers from across Canada participated in focus groups, and answered questions related to the domains of practice as identified in the standards document. Through this input, consumers were able to inform the committee regarding areas of satisfaction and dissatisfaction from their unique perspective. Through this article, the process of consumer collaboration is illustrated in relation to how it shaped Standards revision, and finally how it affected the practitioners involved.

Antimatter plasmas in a multipole trap for antihydrogen

We have demonstrated storage of plasmas of the charged constituents of the antihydrogen atom, antiprotons and positrons, in a Penning trap surrounded by a minimum-B magnetic trap designed for holding neutral antiatoms. The neutral trap comprises a superconducting octupole and two superconducting, solenoidal mirror coils. We have measured the storage lifetimes of antiproton and positron plasmas in the combined Penning-neutral trap, and compared these to lifetimes without the neutral trap fields. The magnetic well depth was 0.6 T, deep enough to trap ground state antihydrogen atoms of up to about 0.4 K in temperature. We have demonstrated that both particle species can be stored for times long enough to permit antihydrogen production and trapping studies.

Infantile clivus chordoma without clivus involvement: case report and review of the literature

BACKGROUND

We present a giant clival chordoma with disseminated disease but without involvement of the clivus. To our knowledge, this is the youngest child and only the second case, presenting without base of skull involvement, in paediatric literature and the fourth reported case of a chordoma in a patient with tuberous sclerosis.

DISCUSSION

We discuss the subtle presentation, difficulties in diagnosis and management and also review the literature.

Do pharmacy staff recommend evidenced-based smoking cessation products? A pseudo patron study

OBJECTIVE

To determine whether pharmacy staff recommend evidence-based smoking cessation aids.

METHODS

Pseudo patron visit to 50 randomly selected Sydney pharmacies where the pseudo patron enquired about the 'best' way to quit smoking and about the efficacy of a non-evidence-based cessation product, NicoBloc.

RESULTS

Nicotine replacement therapy was universally stocked and the first product recommended by 90% of pharmacies. After prompting, 60% of pharmacies, either also recommended NicoBloc or deferred to 'customer choice'. About 34% disparaged the product.

CONCLUSIONS

Evidence-based smoking cessation advice in Sydney pharmacies is fragile and may be compromised by commercial concerns. Smokers should be provided with independent point-of-sale summaries of evidence of cessation product effectiveness and warned about unsubstantiated claims.

"Banned from the streets I have paid to use": an analysis of Australian print media coverage of proposals for passenger and night driving restrictions for young drivers

OBJECTIVE

To catalogue arguments that can be anticipated in public debate when passenger and night driving restrictions are being advocated.

DESIGN AND SETTING

Frame analysis of all relevant coverage of these topics in Australian print media during the three month period between June and September 2004 when intensive debate on the topic occurred.

MAIN OUTCOME MEASURES

Debating frames used in reports and commentary on passenger and night driving restrictions.

RESULTS

There were 52 relevant articles published containing seven distinct frames supporting the restrictions and six opposing them. Overall, more instances of frames supporting the restrictions were published; these mostly focused on the potential for saving lives. Opposition to the restrictions focused largely on their inappropriateness as a road safety measure as well as on the importance of young people's autonomy and freedom.

CONCLUSIONS

Advocates of passenger and night driving restrictions have a number of arguments available to advance their case; however, it is important to anticipate and address possible counter arguments. Future research should address the saliency of different arguments to the public and key decision makers in government.

Seizure duration following sarin exposure affects neuro-inflammatory markers in the rat brain

The current study was aimed to characterize for the first time the alterations in the characteristic neuro-inflammatory markers triggered by sarin exposure in the rat's brain, and to investigate its dependency on seizure duration. Centrally mediated seizures are a common consequence of exposure to organophosphates (OP) despite conventional treatment with atropine and an oxime. In the present study midazolam, was used to control duration and intensity of seizures. The levels of the pro-inflammatory cytokine peptides IL-1beta, IL-6, TNF-alpha and prostaglandin E2 (PGE2) were monitored at various times after sarin exposure in the hippocampus and cortex of rats treated with midazolam following 5 or 30 min of seizure activity. Biochemical evaluation of brain tissues revealed a significant increase in the level of the pro-inflammatory peptides starting at 2 h and peaking at 2-24 h following sarin. Hippocampal values of IL1-beta increased from 1.2+/-0.1 pg/mg tissue (control), to 2.4+/-0.3 at 2 h (5 min seizure) and to 9.3+/-2.5 at 8h (30 min seizure). PGE2 level in the hippocampus increased up to 24 h following exposure (from 56+/-3 to 175+/-26 and 277+/-28 pg/mg tissue) following 5 and 30 min of seizure activity respectively. Thus, unlike limitation of seizures to 5 min by midazolam, delayed treatment (30 min) resulted in prolonged seizures and pronounced increase in cytokines and PGE2. In addition, a second increase in inflammatory markers was observed 30 days following sarin exposure only in rats treated following 30 min of seizure activity. Histological evaluation of the rat brain, conducted in this study, revealed lack of damage in the hippocampus and piriform cortex with minor lateral ventricles enlargement in few animals following 5 min of sarin-induced seizure activity. In contrast, marked histological damage to the brain was demonstrated following 30 min of seizure activity, consisting severe damage to the hippocampus, piriform cortex and some thalamic nuclei. In summary, a novel characterization of the prolonged central neuro-inflammatory process that accompanies sarin exposure is presented. The timing of the anticonvulsive treatment was shown to be crucial in modulation of the neuro-inflammatory response, and may implicate the consequent long-term brain damage.

The use of high resolution magnetic resonance imaging in the prenatal diagnosis of fetal nuchal tumors

Fetal magnetic resonance imaging (fetal MRI) is an important adjunct to antenatal imaging especially when neonatal surgery is contemplated. We report two cases of fetal nuchal tumors, which were diagnosed incidentally on an ultrasound scan and had fetal MRI to aid diagnosis, prognosis, counseling and management planning. In the first case, fetal MRI aided diagnosis and prenatal multidisciplinary management of a cervical teratoma. Tracheal involvement could not be excluded and an ex-utero intrapartum treatment procedure was planned. Postnatal MRI and angiography provided further information prior to surgery. In the second case, fetal MRI assisted thorough counseling following the finding of a cervical lesion thought to be a cervical teratodermoid, a multicystic hygroma or congenital lymphectasia. The parents opted for termination of the pregnancy. Postmortem findings confirmed the extent of involvement of surrounding structures diagnosed prenatally. The mass was found to be a hamartomatous hemangiolymphangioma.

Ensuring smokers are adequately informed: reflections on consumer rights, manufacturer responsibilities, and policy implications

The right to information is a fundamental consumer value. Following the advent of health warnings, the tobacco industry has repeatedly asserted that smokers are fully informed of the risks they take, while evidence demonstrates widespread superficial levels of awareness and understanding. There remains much that tobacco companies could do to fulfil their responsibilities to inform smokers. We explore issues involved in the meaning of "adequately informed" smoking and discuss some of the key policy and regulatory implications. We use the idea of a smoker licensing scheme-under which it would be illegal to sell to smokers who had not demonstrated an adequate level of awareness-as a device to explore some of these issues. We also explore some of the difficulties that addiction poses for the notion that smokers might ever voluntarily assume the risks of smoking.

Accidental head injuries in children under 5 years of age

AIM

To evaluate the type and nature of head injuries sustained by children under the age of 5 years who present to a busy accident and emergency (A&E) department following an accidental fall.

MATERIALS AND METHODS

This study included all children under the age of 5 years, who over an 8-month period were referred to our A&E Department with head injury following an accidental fall. Data were collected regarding the height of the fall, whether or not stairs were involved, the type of surface that the child landed on and the height of the child. This was correlated with any soft-tissue injury or skull fracture.

RESULTS

A total of 72 children (aged 4 months to 4.75 years) fulfilled all the criteria for an accidental fall. The heights of the falls ranged from less than 50 cm to over 3 m, with the majority below 1 m. Of the falls, 49 were onto a hard surface and 23 were onto a soft surface. Of the 72 children, 52 had visible evidence of head injury, 35 (71%) of 49 being the result of falls onto hard surfaces and 17 (74%) of 23 onto soft (carpeted) surfaces. There was no significant difference in the type of surface that resulted in a visible head injury. A visible head injury was seen in all children who fell from a height of over 1.5 m and in 95% of children who fell over 1 m. Of the 72 children, 32 (44%) had skull radiographs performed in accordance with established guidelines and 4 (12.5%) were identified as having a fracture. Of the 3 linear parietal fractures 2 were inflicted by falls of just over 1 m (from a work surface) and 1 by a fall of 80 to 90 cm onto the hard-edged surface of a stone fire surround. The 4th was a fracture of the base of skull following a fall from more than 3 m (from a first-storey window).

CONCLUSIONS

In the vast majority of domestic accidents children do not suffer significant harm. Skull fractures are rare and probably occur in less than 5% of cases. To cause a skull fracture the fall needs to be from over 1 m or, if from a lesser height, then a small-area impact point should be considered an integral component of the injury.

Protection and inflammatory markers following exposure of guinea pigs to sarin vapour: comparative efficacy of three oximes

The purpose of the present study was to compare the antidotal efficacy and the combined effects on inflammatory markers of three oximes--toxogonine, TMB4 and 2-PAM--in combination with anticholinergic drugs following exposure to sarin vapour by inhalation. Guinea pigs restrained in plethysmographs were exposed to various doses of sarin vapour (in the range of 1.4-4.4LD50). The antidotal mixture was injected immediately (5-20 s) following exposure (3 mg kg(-1) atropine and 1 mg kg(-1) benactyzine in combination with 6 mg kg(-1) toxogonine, 2 mg kg(-1) TMB4 or 12 mg kg(-1) 2-PAM). Bronchoalveolar lavage (BAL) samples were taken from surviving animals 24 h after exposure to determine the levels of inflammatory markers. A differential cell count was performed in BAL samples on Giemsa-stained slides. The inflammatory markers--histamine and prostaglandins (PGE)--were measured in BAL using radioimmunoassay (RIA) techniques. The survival rate in the various treatment groups and analysis of BAL samples showed that: (i) Toxogonine, TMB4 and 2-PAM, without pyridostigmine pretreatment, at doses that were proportional to their doses in the respective auto-injectors, exhibited similar antidotal efficacy against sarin exposure. (ii) The results demonstrated that a centrally acting anticholinergic drug is essential in the antidotal mixture to ensure survival. (iii) Histamine release and eosinophilia following sarin inhalation might require additional intervention, aimed at reducing the symptoms of allergic reaction and possibly expediting recovery.

Advocacy in action: extreme corporate makeover interruptus: denormalising tobacco industry corporate schmoozing

The tobacco industry continues to seek corporate "respectability", despite being responsible for the deaths of millions of smokers worldwide every year.

A mire of highly subjective and ineffective voluntary guidelines: tobacco industry efforts to thwart tobacco control in Malaysia

OBJECTIVE

To describe tobacco industry efforts in Malaysia to thwart government efforts to regulate tobacco promotion and health warnings.

METHODS

Systematic keyword and opportunistic website searches of formerly private tobacco industry internal documents made available through the Master Settlement Agreement and secondary websites; relevant information from news articles and financial reports.

RESULTS

Commencing in the 1970s, the industry began to systematically thwart government tobacco control. Guidelines were successfully promoted in the place of legislation for over two decades. Even when the government succeeded in implementing regulations such as health warnings and advertising bans they were compromised and acted effectively to retard further progress for years to come.

CONCLUSION

Counter-measures to delay or thwart government efforts to regulate tobacco were initiated by the industry. Though not unique to Malaysia, the main difference lies in the degree to which strategies were used to successfully counter stringent tobacco control measures between 1970 and 1995.

The Philippine tobacco industry: "the strongest tobacco lobby in Asia"

OBJECTIVE

To highlight revelations from internal tobacco industry documents about the conduct of the industry in the Philippines since the 1960s. Areas explored include political corruption, health, employment of consultants, resisting pack labelling, and marketing and advertising.

METHODS

Systematic keyword Minnesota depository website searches of tobacco industry internal documents made available through the Master Settlement Agreement.

RESULTS

The Philippines has long suffered a reputation for political corruption where collusion between state and business was based on the exchange of political donations for favourable economic policies. The tobacco industry was able to limit the effectiveness of proposed anti-tobacco legislation. A prominent scientist publicly repudiated links between active and passive smoking and disease. The placement of health warning labels was negotiated to benefit the industry, and the commercial environment allowed it to capitalise on their marketing freedoms to the fullest potential. Women, children, youth, and the poor have been targeted.

CONCLUSION

The politically laissez faire Philippines presented tobacco companies with an environment ripe for exploitation. The Philippines has seen some of the world's most extreme and controversial forms of tobacco promotion flourish. Against international standards of progress, the Philippines is among the world's slowest nations to take tobacco control seriously.

The tobacco industry's accounts of refining indirect tobacco advertising in Malaysia

OBJECTIVE

To explore tobacco industry accounts of its use of indirect tobacco advertising and trademark diversification (TMD) in Malaysia, a nation with a reputation for having an abundance of such advertising.

METHODS

Systematic keyword and opportunistic website searches of formerly private tobacco industry internal documents made available through the Master Settlement Agreement.

RESULTS

132 documents relevant to the topic were reviewed. TMD efforts were created to advertise cigarettes after advertising restrictions on direct advertising were imposed in 1982. To build public credibility the tobacco companies set up small companies and projected them as entities independent of tobacco. Each brand selected an activity or event such as music, travel, fashion, and sports that best suited its image. RJ Reynolds sponsored music events to advertise its Salem brand while Philip Morris used Marlboro World of Sports since advertising restrictions prevented the use of the Marlboro man in broadcast media. Despite a ban on tobacco advertisements in the mass media, tobacco companies were the top advertisers in the country throughout the 1980s and 1990s. The media's dependence on advertising revenue and support from the ruling elite played a part in delaying efforts to ban indirect advertising.

CONCLUSION

Advertising is crucial for the tobacco industry. When faced with an advertising ban they created ways to circumvent it, such as TMDs.

"Asian yuppies...are always looking for something new and different": creating a tobacco culture among young Asians

OBJECTIVE

To identify and analyse the themes employed by the Asian based transnational tobacco companies to construct a tobacco culture among Asian young men and women.

METHODS

Systematic review of relevant tobacco industry documents made public through the Master Settlement Agreement.

RESULTS

The industry utilised six vehicles and themes to construct a tobacco culture in Asia: music, entertainment (including nightclubs, discos, and movies), adventure, sport (including motorsports, soccer, and tennis), glamour (beauty and fashion), and independence.

CONCLUSIONS

The tobacco industry set about constructing a tobacco culture that sought to make smoking desirable, even normal, for young men and women. Understanding the way industry constructed this culture provides insights into ways that culture might now be challenged. Countering the transnational nature of many activities will require coordinated effort at the international, regional, and national levels. Implementation of the Framework Convention on Tobacco Control (FCTC) will be a powerful tool in this process. All nations throughout Asia are encouraged to support the FCTC and its broad protocols addressing advertising and sponsorship. Measures are also required to disassociate smoking from progress in sex equality.

"A phony way to show sincerity, as we all well know": tobacco industry lobbying against tobacco control in Hong Kong

OBJECTIVE

To examine the tobacco industry's efforts to influence public policy and block the legislative process on tobacco control in Hong Kong, 1973 to 1997.

METHOD

Systematic review of relevant tobacco industry documents made public via the Master Settlement Agreement.

RESULTS

The tobacco industry in Hong Kong has sought to manipulate the policymaking process and delay the introduction of tobacco control legislation in Hong Kong from at least 1973. The industry ensured that each of the government's initial meagre steps toward tobacco control were delayed and thwarted by drawn out "cooperation" followed by voluntary concessions on issues the industry regarded as minor. By the 1980s the government had became increasingly active in tobacco control and introduced a number of initiatives, resulting in some of the tightest legislative restrictions on smoking in Asia. The tobacco industry was successful in thwarting only one of these initiatives.

CONCLUSIONS

Throughout the 1980s and 1990s two factors played a significant role in hindering the tobacco industry from successfully blocking policy initiatives: a growing political imperative, and an active and sophisticated tobacco control movement. Political will to promote public health and a strong tobacco control advocacy presence can enable governments to resist the enormous pressure exerted upon them by multinational tobacco companies.

Industry sponsored youth smoking prevention programme in Malaysia: a case study in duplicity

OBJECTIVE

To review tobacco company strategies of using youth smoking prevention programmes to counteract the Malaysian government's tobacco control legislation and efforts in conducting research on youth to market to them.

METHODS

Systematic keyword and opportunistic website searches of formerly private internal industry documents. Search terms included Malay, cmtm, jaycees, YAS, and direct marketing; 195 relevant documents were identified for this paper.

RESULTS

Industry internal documents reveal that youth anti-smoking programmes were launched to offset the government's tobacco control legislation. The programme was seen as a strategy to lobby key politicians and bureaucrats for support in preventing the passage of legislation. However, the industry continued to conduct research on youth, targeted them in marketing, and considered the teenage market vital for its survival. Promotional activities targeting youth were also carried out such as sports, notably football and motor racing, and entertainment events and cash prizes. Small, affordable packs of cigarettes were crucial to reach new smokers.

CONCLUSION

The tobacco industry in Malaysia engaged in duplicitous conduct in regard to youth. By buying into the youth smoking issue it sought to move higher on the moral playing field and strengthen its relationship with government, while at the same time continuing to market to youth. There is no evidence that industry youth smoking prevention programmes were effective in reducing smoking; however, they were effective in diluting the government's tobacco control legislation.

A "clean cigarette" for a clean nation: a case study of Salem Pianissimo in Japan

OBJECTIVE

To illustrate, through internal industry documents, how RJ Reynolds exploited the concerns of the Japanese society about cleanliness to market the concept of cleaner, implicitly healthier cigarettes in Japan.

DESIGN

Systematic keyword and opportunistic website searches of formerly private internal industry documents.

RESULTS

Industry documents show that RJ Reynolds developed marketing plans based upon their cultural assumptions of Japanese people as fastidious about hygiene and manners, and with relatively high penchants to try new products. RJ Reynolds found there was also a growing concern for health, the environment, and smokers were conscious about annoying others. Deodorised consumer products were one of Japan's biggest trends. These characteristics presented RJ Reynolds with a profitable formula for marketing Salem Pianissimo, a clean cigarette with less smell and smoke. Salem Pianissimo, a 100 mm cigarette claiming to contain 1 mg tar and 0.1 mg nicotine, targeted women since menthol cigarettes were popular among 18-24 year old female smokers, although Japan's law prohibited those below 20 years to smoke and the tobacco industry had a voluntary code disallowing advertising to women and youth.

CONCLUSION

RJ Reynolds successfully launched its clean cigarette, Salem Pianissimo, in Japan aiming to exploit perceived cultural characteristics such as a penchant for cleanliness, an eagerness to try new products, and social harmony.

"Asia is now the priority target for the world anti-tobacco movement": attempts by the tobacco industry to undermine the Asian anti-smoking movement

STUDY OBJECTIVE

To identify and examine the strategies utilised by multinational tobacco companies to undermine and discredit key anti-tobacco activists and organisations in the Asian region.

METHOD

A series of case studies drawing upon material gathered through systematic reviews of internal tobacco industry documents.

DATE SOURCES

Tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement.

RESULTS

The industry sought to identify, monitor, and isolate key individuals and organisations. The way industry went about fulfilling this mandate in the Asian region is discussed. Industry targetted individuals and agencies along with the region's primary anti-smoking coalition.

CONCLUSIONS

Attack by multinational tobacco companies is a virtual quid pro quo for any individual or agency seriously challenging industry practices and policies. Understanding their tactics allows anticipatory strategies to be developed to minimise the effectiveness of these attacks.

"The world's most hostile environment": how the tobacco industry circumvented Singapore's advertising ban

OBJECTIVE

To review how tobacco transnational companies conducted their business in the hostile environment of Singapore, attempting to counter some of the government's tobacco control measures; to compare the Malaysian and the Singaporean governments' stance on tobacco control and the direct bearing of this on the way the tobacco companies conduct their business.

METHODS

Systematic keyword and opportunistic website searches of formerly private internal industry documents.

RESULTS

The comprehensive prohibition on advertising did not prevent the companies from advertising cigarettes to Singaporeans. Both British American Tobacco and Philip Morris used Malaysian television to advertise into Singapore. To launch a new brand of cigarettes, Alpine, Philip Morris used a non-tobacco product, the Alpine wine cooler. Other creative strategies such as innovative packaging and display units at retailers were explored to overcome the restrictions. Philip Morris experimented with developing a prototype cigarette using aroma and sweetened tipping paper to target the young and health conscious. The industry sought to weaken the strong pack warnings. The industry distributed anti-smoking posters for youth to retailers but privately salivated over their market potential.

"The contemporary, irreverent brand of youth with an independent streak": BAT's youth promotions in Myanmar

"British American Tobacco strongly believes children should not smoke, and smoking should only be for adults who understand the risks associated with it. Our Group companies support and run programmes worldwide tackling underage smoking, and we are committed to pooling our resources and experience globally with others in the tobacco industry--and with governments and NGOs--to help prevent youth smoking. Along with the other two largest international tobacco groups--Philip Morris International and Japan Tobacco International--our Group companies have funded and supported more than 130 Youth Smoking Prevention (YSP) programmes in more than 70 countries. We fully support laws and regulations on a minimum age for buying tobacco products, and penalties for retailers who break the law. Our company policy worldwide is not to market to anyone under 18 years old, or more if the law in a particular country sets the age higher."--BAT website November 2003.

Tobacco industry efforts to erode tobacco advertising controls in Hungary

OBJECTIVE

To review strategies of transnational tobacco companies (TTCs) at creating a favourable advertising environment for their products in Hungary, with special regard to efforts resulting in the liberalisation of tobacco advertising in 1997.

METHOD

Analysis of internal tobacco industry documents relevant to Hungary available on the World Wide Web. Transcripts of speeches of members of the Parliament during the debate of the 1997 advertising act were also reviewed.

CONCLUSIONS

The tobacco companies not only entered the Hungarian market by early participation in the privatisation of the former state tobacco monopoly, but also imported theirsophisticated marketing experiences. Evasion and violation of rules in force, creation of new partnerships, establishment and use of front groups, finding effective ways for influencing decision makers were all parts of a well orchestrated industry effort to avoid a strict marketing regulation for tobacco products.

MRI of the marrow in the paediatric skeleton

Magnetic resonance imaging (MRI) has greatly advanced evaluation of marrow diseases of the paediatric skeleton. As with many other aspects of paediatric radiology it is important to recognize the normal variations in the appearance of the marrow that occur in the growing child. These normal variations need to be differentiated from diseases and conditions that affect the marrow. This review describes the normal changes that occur in children with age, and the appearances of the pathological changes seen in infection, infiltration, haematological disorders, transplantation and radiation therapy.

Advocacy for public health: a primer

Public health advocacy is the strategic use of news media to advance a public policy initiative, often in the face of opposition.

Lack of apolipoprotein-E exacerbates experimental allergic encephalomyelitis

Experimental autoimmune encephalomyelitis (EAE) was found to have a chronic and significantly worse course in apolipoprotein-E (apoE) deficient female mice when compared with matched controls. Disease measures compared included incidence of EAE (64% versus 31%, P < 0.05, chi2 test), maximal clinical score (average +/- SD 2.81 +/- 2.5 versus 0.75 +/- 1.1, P < 0.01, Mann-Whitney test) and mortality (27.3% versus 0%, P = 0.02, Mann-Whitney test and chi2 test). ApoE deficient mice had significantly increased lymphocyte proliferation responses to both myelin antigens and mitogens and significantly more infiltrating lesions in the central nervous system (CNS) in histopathology. Defective neuronal repair mechanisms and enhanced immune reactivity in apoE deficient mice may explain our findings. Clinical implications for MS are discussed.

"Can't stop the boy": Philip Morris' use of Healthy Buildings International to prevent workplace smoking bans in Australia

OBJECTIVE

To document the relationship of the indoor air consultancy company Healthy Buildings International (HBI) with the Australian tobacco industry.

DESIGN

Systematic keyword and opportunistic website searches of tobacco industry internal documents made available through the Master Settlement Agreement.

RESULTS

Since 1987 HBI has played a high profile role in advancing the Australian tobacco industry's concerns to prevent building owners introducing smoke-free workplaces by advocating for ventilation solutions. HBI invoiced Philip Morris' US lawyers Covington and Burling for work undertaken in Australia and sought to publicly deny its association with the industry. HBI breached Standards Australia protocols in providing PM with confidential public submissions made to a review of the Australian standard on ventilation and acted as an undeclared cipher into the review for Philip Morris's concerns, leading to the eventual dismissal of the HBI representative from the standards subcommittee.

CONCLUSIONS

HBI in Australia exemplifies the tobacco industry's use of third party strategy in publicly advancing a case against smoke-free indoor air.

"A deep fragrance of academia": the Australian Tobacco Research Foundation

OBJECTIVES

(1) To review the history of the tobacco industry supported Australian Tobacco Research Foundation (ATRF)(1970-1994) for evidence of the industry's use of the Foundation to further its objectives that "more research was needed" on smoking and health and to promulgate the view that nicotine was not addictive. (2) To review efforts by public health advocates to discredit the ATRF as a public relations tool used by the Australian industry.

METHODS

Systematic search of previously internal industry documents released through the US Master Settlement Agreement.

RESULTS

The ATRF was headed by prestigious Australian medical scientists, with at least one considered by the industry to be "industry positive". An international ATRF symposium on nicotine was vetted by the industry and heavily attended by industry approved scientists. Following sustained criticism from the health and medical community about the industry's creation of the ATRF to further its objectives, the ATRF's scientific committee was provoked to publicly declare in 1988 that smoking was a causative agent in disease. This criticism led to growing ATRF boycotts by scientists and substandard applications, causing the industry to see the ATRF as being poor value-for-money and eventually abandoning it.

CONCLUSIONS

The raison d'etre for the ATRF's establishment was to allow the Australian industry to point to its continuing commitment to independent medical research, with the implied corollary that tobacco control measures were premature in the face of insufficient evidence about tobacco's harms. Sustained criticism of tobacco industry funded research schemes can undermine their credibility among the scientific community.

"We are anxious to remain anonymous": the use of third party scientific and medical consultants by the Australian tobacco industry, 1969 to 1979

OBJECTIVE

To document the history of visits to Australia by tobacco industry sponsored scientists and news media reports about smoking and health matters generated by their visits.

DESIGN

Systematic keyword and opportunistic website searches of tobacco industry internal documents made available through the Master Settlement Agreement.

RESULTS

At least nine sponsored scientists visited Australia from 1969 until 1979. The industry sought to promote the scientists as independent from the industry and on occasion, scientists publicly lied about their industry connections. The industry was sometimes delighted with the extensive and favourable media coverage given to the visits.

CONCLUSIONS

These media reports are likely to have influenced many who were exposed to them to believe that the evidence against smoking remained equivocal.

"Avoid health warnings on all tobacco products for just as long as we can": a history of Australian tobacco industry efforts to avoid, delay and dilute health warnings on cigarettes

OBJECTIVE

To review critically the history of Australian tobacco industry efforts to avoid, delay, and dilute pack warnings on cigarettes.

DESIGN

Systematic keyword and opportunistic website searches of tobacco industry internal documents made available through the Master Settlement Agreement.

RESULTS

Four industry strategies and six recurrent arguments used by the industry are described, which were used to thwart the passage of three generations of health warnings (implemented in 1973, 1987, and 1995). These strategies are shown to have been associated with major delays in the implementation of the warnings and in keeping them inconspicuous, unattributed to the industry and non-specific, and particularly in delaying the use of warnings about addiction. The industry today continues to oppose warnings, which might "repel" smokers from tobacco use.

CONCLUSIONS

Efforts by governments to introduce potent health warnings will be resisted by the tobacco industry. Tobacco control advocates should anticipate and counter the strategies and arguments used by the industry, which are described in this paper if they wish to maximise the use of the pack as a vehicle for raising awareness about the harms of smoking.

"Australia is one of the darkest markets in the world": the global importance of Australian tobacco control

"Australia is one of the darkest markets in the world... it probably is the darkest, I mean ourselves and Canada fight every month for who's got the darkest conditions to do tobacco manufacturing and marketing. And one of the things we can offer the world is what we do best, which is how to work, maximize, proactively drive our market position in a market that's completely dark. Now that takes a different skillset... a different type of learning. We need to export that... we know we have a lot of expatriates who come down to Australia for learning. they can come here and learn these techniques and take them back to Europe or Latin America or to the United States or to Africa... But the other thing that is really good for us is that we are also a huge net exporter of Australian talent. about 30 or 40 people currently off-shore... We do things really differently here than most other BAT organizations." David Crowe, Marketing Director, British American Tobacco (BAT) Australia(1).

"Some convincing arguments to pass back to nervous customers": the role of the tobacco retailer in the Australian tobacco industry's smoker reassurance campaign 1950-1978

BACKGROUND

Epidemiological studies and reports on smoking and health published in the 1950s and 1960s threatened the tobacco industry worldwide, which acted to reassure smokers and counteract mounting evidence that smoking posed a serious risk to smokers' health.

OBJECTIVE

To document the use of tobacco retailers (1) as a conduit to pass messages of reassurance onto smokers, and (2) to recruit youth and women into smoking.

METHODS

Review of an extensive collection of Australian tobacco retail trade journals (1950-1978) for articles consistent with the industry's efforts to counter messages about smoking and health, and how to attract non-smokers, particularly youth and women.

RESULTS

The main arguments advanced in the journals included the notion that air pollution and other substances cause cancer, that "statistics" did not constitute proof in the tobacco health scare, and that the industry was committed to research into the causes of cancer and into developing a "safer" cigarette.

CONCLUSIONS

Numerous articles designed to be reiterated to customers were published, arguing against the link between tobacco and ill health. Tobacco retailers, salesmen and retail trade organisations played a significant role in dissembling the tobacco health nexus. Tobacco retail journals may be an important component in tobacco industry misinformation strategies.

Smoking, disease, and obdurate denial: the Australian tobacco industry in the 1980s

OBJECTIVE

To contrast the Australian tobacco industry's awareness of the diseases caused by smoking with their aggressive public denial on the relation between smoking and disease in the 1980s.

DESIGN

Analysis of 325 industry documents from the world wide web.

RESULTS

In the 1980s Australian cigarette manufacturers were informed constantly by the international industry of the medical consensus that smoking caused disease. In addition Philip Morris (Australia) Limited received reports of Philip Morris' international biological research programme and visited its Richmond research facility; and WD&HO Wills part funded, co-managed, and contributed research to the British American Tobacco groups' biological research programme. Despite this knowledge, the Australian manufacturers had a policy of arguing to their employees, decision makers, and the general public that questions of smoking and disease were unresolved. The industry catalogued the literature, developed arguments against the main claims made by health groups, and attacked public health advocates who made statements linking smoking to death and disease. Industry studies suggested that a 20-30% minority of the Australian public agreed with the industry on smoking and disease, diminishing across the decade.

CONCLUSION

Australian manufacturers were clearly negligent in the 1980s, deliberately working to undermine Australians' understandings of the diseases caused by smoking despite their own private knowledge. Continuing scepticism about smoking and disease, corresponding with the industry's deceptions, exists in Australian smokers today, suggesting that their actions may have slowed the rate of decline in smoking prevalence. These revelations provide important evidence for Australian litigation and advocacy.

"It is possible he is a kind of nut": how the tobacco industry quietly promoted Dr William Whitby

Dr William Whitby was a general practitioner in Sydney who, from 1978 until about 1987, self published two books extolling the virtues of smoking and ridiculing anti-smoking claims. Privately the tobacco industry regarded him as "nutty", while nonetheless believing that his views should be promoted. They quietly supported him by distributing his book, offering legal advice, and persuading him to take media training. Many Australians would have been exposed to his views.

"Conclusions about exposure to ETS and health that will be unhelpful to us": how the tobacco industry attempted to delay and discredit the 1997 Australian National Health and Medical Research Council report on passive smoking

BACKGROUND

Major reviews of the health effects of passive smoking have been subjected to tobacco industry campaigns to refute the scientific evidence. Following the 1992 US Environmental Protection Agency review, the Australian National Health and Medical Research Council (NHMRC) initiated a review of the health effects of passive smoking. At the time of this review, evidence that environmental tobacco smoke causes disease was being increasingly accepted in courts of law and voluntary adoption of smoking restrictions was rapidly growing.

OBJECTIVE

To demonstrate how the tobacco industry attempted to delay and discredit the publication of a report on passive smoking that the tobacco industry anticipated to contain recommendations that would be unfavourable to their business.

METHODS

A search of tobacco industry documents on the Master Settlement Agreement websites was conducted using the terms and acronyms representative of the NHMRC review.

RESULTS

The tobacco industry sought to impede the progress of the NHMRC Working Party by launching an intensive campaign to delay and discredit the report. The main strategies used were attempts to criticise the science, extensive use of Freedom of Information provisions to monitor all activity of the group, legal challenges, ad hominem attacks on the credibility of the Working Party members, rallying support from industry allies, and influencing public opinion through the media.

CONCLUSIONS

The Australian tobacco industry deliberately impeded the NHMRC Working Party's progress and successfully prevented the publication of the report's recommendations. The tobacco industry's motivation and capacity to disrupt the advancement of scientific knowledge and policy in tobacco control should be recognised and anticipated.

Bone within a bone

The "bone within a bone" appearance is a well-recognized radiological term with a variety of causes. It is important to recognize this appearance and also to be aware of the differential diagnosis. A number of common conditions infrequently cause this appearance. Other causes are rare and some remain primarily of historical interest, as they are no longer encountered in clinical practice. In this review we illustrate some of the conditions that can give the bone within a bone appearance and discuss the physiological and pathological aetiology of each where known.

124CRYOPRESERVATION OF WHITE-TAILED DEER (ODOCOILEUS VIRGINIANUS) SEMEN

The methods for collecting and freezing deer semen have been, for the most part, limited to two species; red deer ( Cervus elaphus) and fallow deer ( Dama dama) (Asher et al., 2000 Anim. Reprod. Sci. 62, 195–211). The object of this study was to evaluate the progressive motility and effects of a thermal stress test on white-tailed deer (WTD) semen frozen in Biladyl extender (Mini Tube, Verona, WI, USA). Semen was collected by electroejaculation from WTD bucks (n=7, ages 1.5–2.5 years) during the breeding season. This trial was the second collection for one buck (#0025) and the third collection for the other 6 bucks. The bucks were immobilized with a xylazine/ketamine mixture i.m. (2mgkg−1 Vedco, Inc., St. Joseph, MO, 2.2mgkg−1 ketamine HCl, Fort Dodge Animal Health, Fort Dodge, IA, USA) and electroejaculated with a Pulsator IV unit (Lane Manufacturing, Denver, Co). Semen was extended 1:1 with Biladyl A, and then slowly cooled to 4°C. Once cooled, semen was extended with equal amounts of Biladyl part A, then part B, to a final concentration of 160×106cells/mL. The extended semen was then loaded into 0.25-cc straws, placed over liquid nitrogen (LN2) in vapors (−80°C) for 10min, and then plunged into LN2. Straws were stored in a LN2 tank for 3 months. Semen was thawed in a 38.5°C water bath for 45s, then placed in a warm test tube and incubated at 38.5°C for 5min before progressive motility was evaluated using a computer program (Sperm Vision, Mini Tube). A thermal stress test was performed by incubating thawed samples at 38.5°C for 1h. Results of the stress test were graded as either passed (progressive motility ≥50%) or failed (progressive motility&lt;50%). Results are shown in the table below. Our results show that the protocol described above is suitable for the cryopreservation of white-tailed deer semen. These data suggest that the initial post-thaw progressive motility may not accurately represent the potential progressive motility of the spermatozoa (e.g. WTD s 0038 &amp; 0103). Table 1 Volume collected and post thaw evaluation of white-tailed deer semen

Tobacco industry efforts to keep cigarettes affordable: a case study from Hungary

OBJECTIVE

To review strategies of multinational tobacco companies aimed at keeping tobacco products affordable to smokers in Hungary and to provide background information on the Hungarian request for the delayed introduction of minimum European Union tobacco excise duty levels.

METHOD

Review of internal tobacco industry documents available on the World Wide Web, downloaded between 26 July 2001 and 31 October 2002.

CONCLUSIONS

Appropriate pricing strategies and lobbying for low tobacco tax policies were used by the tobacco industry in Hungary to keep cigarettes affordable to the public. During the 1990s and in the early 2000s transnational tobacco companies (TTCs) were still able to prevent substantial cigarette price rises, which would have been desirable for more effective control of Hungarian tobacco use. Strategies used by TTCs included the creation of new partnerships, use of supportive MPs, communication around tobacco tax issues and also the successful management of the differences in approaches used by individual companies regarding taxation of tobacco products. These resulted in the adoption of governmental policy aimed at delaying the introduction of the EU directive on the minimum tax levels of retail prices of cigarettes.